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Browsing Research and Education by Author "Abdullah, Shuaib"
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Item Impact of Crossing Strategy on Intermediate-Term Outcomes After Chronic Total Occlusion Percutaneous Coronary Interventions(2016-01-19) Amsavelu, Suwetha; Christakopoulos, Georgios E.; Tarar, Muhammad Nauman J.; Patel, Krishna; Rangan, Bavana V.; Stetler, Jeffrey; Roesle, Michele; Resendes, Erica; Grodin, Jerrold; Abdullah, Shuaib; Banerjee, Subhash; Brilakis, Emmanouil S.BACKGROUND: There is ongoing controversy on the optimal crossing strategy selection for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), especially on the relative merits of antegrade dissection/re-entry and the retrograde approach. METHODS: We retrospectively examined the clinical outcomes of 173 consecutive patients who underwent successful CTO PCI at our institution between January 2012 and March 2015. RESULTS: Mean age was 65 ± 8 years and 98% of the patients were men with high prevalence of diabetes (60%), prior coronary artery bypass graft surgery (31%) and prior PCI (54%). The successful CTO crossing strategy was antegrade wire escalation in 79 patients (45.5%), antegrade dissection/re-entry in 58 patients (33.5%), retrograde wire escalation in 11 patients (6.4%) and retrograde dissection and re-entry in 25 patients (14.5%). The retrograde approaches was more commonly used in lesions with interventional collaterals (p<0.0001), moderate/severe calcification (p=0.02), blunt stump (p=0.01) and a higher J-CTO score (p=0.0002). Specifically, the retrograde wire escalation was associated with a prior attempt to open the CTO (p=0.05), and the dissection and re-entry approaches for both antegrade and retrograde had a stronger correlation with bifurcation and the distal cap (p=0.004), higher CTO occlusion length (p<0.0001) and higher stent length (p<0.0001). Median follow-up was 11 months. The 12-month incidence of death, myocardial infarction, and acute coronary syndrome/target lesion revascularization/target vessel revascularization was 2.5%, 4.9%, and 24.4%, respectively and was similar across intimal and subintimal crossing strategies. CONCLUSION: Antegrade dissection/re-entry and retrograde approaches are frequently used during CTO PCI and were associated with similarly favorable intermediate-term outcomes as antegrade wire escalation.Item Intravascular Ultrasonography Analysis of the Everolimus-Eluting Stent in Coronary Chronic Total Occlusions(2014-02-04) Navara, Rachita; Michael, Tesfaldet; Papayannis, Aristotelis; Patel, Vishal; Fuh, Eric; Alomar, Mohammed; Moin, Danyaal; Brayton, Kimberly; Mogabgab, Owen; Shorrock, Deborah; Tran, Daniel; Roesle, Michele; Rangan, Bavana; Haagen, Donald; Makke, Loren; Abdullah, Shuaib; Luna, Michael; Addo, Tayo; Banerjee, Subhash; Brilakis, Emmanouil S.PURPOSE: Chronic total coronary occlusions (CTOs) are challenging to treat in part due to high rates of restenosis after stenting. Drug-eluting stents improve outcomes compared to bare metal stents. The goal of the present study was to evaluate the angiographic, intravascular ultrasonography (IVUS) and clinical outcomes after implantation of the Everolimus-Eluting Stent (EES) in CTOs. METHODS: One hundred consecutive CTO patients who were successfully treated using EES at the Dallas VAMC between 2009-2012 were enrolled in the AngiographiC Evaluation of the Everolimus-Eluting Stent in Chronic Total Occlusions (ACE-CTO trial: NCT01012869). Patients underwent follow-up angiography and IVUS imaging at 8 months and clinical follow-up at 12 months. The primary endpoint of this study, binary angiographic restenosis, was defined as >50% minimum lumen diameter stenosis at 8-month follow-up quantitative coronary angiography. The primary endpoint of the IVUS analysis was 8-month in-stent neointimal hyperplasia (NIH) volume (stent volume-lumen volume). RESULTS: Patients had high prevalence of hypertension (91%), hyperlipidemia (90%), diabetes (47%), prior MI (51%), and prior PCI (21%). Of the 89 patients who underwent follow-up angiography, binary in-stent angiographic restenosis occurred in 41 patients (46%), and IVUS analysis was performed in 61 patients. IVUS was not performed in 24 patients (8 of whom had occlusive in-stent restenosis), and suboptimal image quality precluded analysis in 4 patients. Mean and median neointimal hyperplasia volume were 68 ±100 and 26 (0, 91) mm3, respectively. This corresponded to a mean and median percent volume obstruction of 12% ± 15% and 5% (0%, 24%), respectively. No NIH could be detected in 33% of patients. CONCLUSIONS: EES implantation in CTO patients is associated with high rates of angiographic restenosis as well as revascularization, yet most patients derived significant symptomatic improvement despite focal NIH formation.Item Long-Term Outcomes with First vs Second Generation Drug-Eluting Stents in Saphenous Vein Graft Lesions(2014-02-04) Pokala, Nagendra; Menon, Rohan V.; Patel, Siddharth M.; Christopoulos, George; Kotsia, Anna P.; Rangan, Bavana V.; Roesle, Michele; Abdullah, Shuaib; Grodin, Jerrold; Kumbhani, Dharam J.; Hastings, Jeffrey; Banerjee, Subhash; Brilakis, EmmanouilBACKGROUND: Compared to bare metal stents, first-generation drug-eluting stents (DES) significantly improved post-procedural outcomes in aortocoronary saphenous vein graft (SVG) lesions, but there is limited information on outcomes after use of second-generation DES. METHODS: We compared the outcomes of patients who received first-generation DES (n=82) with those who received second-generation DES (n=166) in SVG lesions at our institution between 2006 and 2013. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization. RESULTS: Mean age was 66.0 years and 97.6% of the patients were men. Mean SVG age was 11.1 ± 0.4 years. First-generation DES were sirolimus-eluting (n=17) and paclitaxel-eluting (n=65) stents. Second-generation DES were everolimus-eluting (n=115) and zotarolimus-eluting (n=51) stents. Median follow-up was 41 months. At 2 years post-procedure, patients with first- and second-generation DES had similar rates of death (20.00% vs. 20.91%, p=0.881), target lesion revascularization (16.13% vs. 20.00%, p=0.541), target vessel revascularization (20.63% vs. 23.16%, p=0.709), myocardial infarction (25.76% vs. 23.00%, p=0.684), and MACE (40.04% vs. 40.87%, p=0.764), respectively. CONCLUSIONS: Outcomes with first and second generation DES in SVGs are similar. Novel stent designs are needed to further improve the clinical outcomes in this challenging lesion subgroup.